Provider Demographics
NPI:1942466560
Name:FITZGIBBON, MINDY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:ANN
Last Name:FITZGIBBON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 I ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4114
Mailing Address - Country:US
Mailing Address - Phone:501-664-0238
Mailing Address - Fax:
Practice Address - Street 1:2600 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5925
Practice Address - Country:US
Practice Address - Phone:501-296-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP#941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist